Active, trim, and a conscientious eater at 48, Jan Snooks thought of herself as “one of the healthiest people” she knew. Her doctor agreed. Remarking on Snooks’ low cholesterol levels, he told the then elementary-school special-ed teacher, “I have patients who would give anything for these results.”

Soon after, in March 2000, Snooks joined friends for five hours of cross-country skiing. She remembers feeling “crummy” afterward and writing it off as altitude sickness. But a few days later, on an exercise bike after work, she felt a sudden, crushing chest pain and thought, “I’m having a heart attack.”

Incredulous, she continued her daily routine for two more weeks, despite intermittent pain—until her husband finally convinced her to see a doctor. After an alarming EKG test, Snooks underwent surgery to put a stent into a blocked artery. Four months later, her doctor discovered another near-total blockage and performed an emergency triple bypass.

Women at risk “With slight variations, I have heard this story all too often,” says Sharonne Hayes, MD, director of the Rochester, Minnesota-based Mayo Clinic Women’s Heart Clinic. Because younger women don’t “look the part,” she says, they can have classic heart-disease symptoms, but neither they—nor their doctors—consider the possibility. And normal cholesterol and blood-pressure readings can falsely reassure them.

In hindsight, Snooks did have relevant family history. Although her parents enjoyed great health, both grandfathers died of heart attacks, at 48 and 58, as did a cousin in his mid-40s. While it’s true that heart disease in a parent or a sibling is a more serious risk factor than heart disease in a more distant relative, heredity may be especially important in predicting cardiovascular disease before age 65, according to Mehmet Oz, MD, director of the Cardiovascular Institute at New York Presbyterian, Columbia University.

Thirty percent to 40 percent of men and women who get heart disease don’t have strong risk factors, says Hayes, so unknown or unfamiliar risk factors must exist. Indeed, after Snooks’ crisis, doctors discovered she had elevated lipoprotein(a) levels. Although not routinely checked, this protein is now known to bond with “bad” LDL cholesterol, greatly increasing its propensity to clog arteries.

Identifying symptoms Many people think of heart disease as a man’s disease, but more women die of it every year—a fact only 8 percent of women know. The disease differs greatly by gender, says Oz, who cofounded Columbia’s Integrative Medicine Program. Ninety percent of men who have heart attacks show hardening of the arteries (atherosclerosis); only 30 percent of women do. Oz explains that cholesterol clogs men’s vessels, the way hair clogs a bathroom drain. But in women, the tube itself gets smaller; it spasms and closes. That’s why women tend to do poorly with surgical solutions, including stents.

“Simply living in a Western society, we are all at risk,” says Hayes. “We should educate ourselves, ask doctors questions, and most important, listen to our bodies and not ignore symptoms.” Hayes recommends that every woman older than 20 get a lipid profile and a blood-pressure test; other experts recommend getting C-reactive protein, homocysteine, and lipoprotein(a) levels checked at least once. Family history doesn’t doom you, she says, but knowing your history may motivate you to lower your risk as much as possible.

Rethinking priorities The good news for women is that heart disease tends to be more reversible for them than it is for men. For instance, the high-fiber, low-fat Ornish diet seems to benefit women in particular. A star graduate of a cardiac rehab program, Snooks now pays more attention to what she eats. “I thought I ate fish a lot, for example,” says the now 52-year-old, “but I really didn’t.” She has also added soyfoods and supplements, such as vitamin E, niacin, coenzyme Q10, and other antioxidants to her diet.

For heart-disease recovery—or prevention—the Mayo Clinic’s Sharonne Hayes recommends eating a variety of foods, including whole grains and 5 to 10 half-cup servings of fruits and vegetables a day. Cooked green leafy vegetables, such as kale, chard, and collard greens, are particularly important, says Susie Hayes, LAc, an acupuncturist in Kirkland, Washington, because they are rich in magnesium, vital for heart health.

Sharonne Hayes also advises commonsense tactics, such as watching salt intake; emphasizing vegetable, soy, and fish protein over other types of animal protein; and choosing “good” fats, such as olive oil. To lower cholesterol, she suggests a nutraceutical such as stanol or sterol ester, which are found in some margarines as well as in over-the-counter gelatin capsules. Look for a multivitamin rich in folate, which helps combat the destructive action of homocysteine, another emerging risk factor. Beneficial herbs, says Susie Hayes, include garlic (Allium sativum), psyllium (Plantago ovata), and English hawthorn (Crataegus laevigata).

From the perspective of Traditional Chinese Medicine, Susie Hayes says, “I would advise avoiding caffeine as well as alcohol and excessively spicy or sweet foods, which can all increase heat in the body.” Internal heat, she explains, can cause compression in the chest, which in turn can contribute to heart symptoms. Women experiencing chest pain, shortness of breath, fatigue, or palpitations, she says, might want to consult with a qualified acupuncturist as well as a doctor.

Another key to cardiac health is regular moderate exercise—30 to 60 minutes a day for healthy people, suggests Sharonne Hayes, and up to that much for cardiac patients, depending on a physician’s recommendation. With a new heart-rate monitor, Snooks now exercises six days a week, usually running, but also skiing, playing tennis, hiking, and working out at the gym. Those without an established exercise habit should “do what they like to do or what they hate least,” says Sharonne Hayes. “Walking is great. Buy a pedometer, set it to steps, and average your total for three days. Ten thousand steps a day is the goal.”

The final piece of Snooks’ recovery has been relaxation. She credits daily meditation sessions, as well as acupuncture and Chinese herbs, with boosting her overall health and calm. Perhaps the most beneficial change, she reports, has been switching to a less-stressful job: librarian.

“Any major illness presents an opportunity to rethink priorities,” says Sharonne Hayes, “so Jan’s job shift was a healthy response.” Stress doesn’t cause heart disease, she explains, but chronic stress tends to interact with other risk factors and make it hard to stick with rehab. Oz agrees. “I tell [my patients] to keep working, have more sex, live a fuller life, and be aware of every moment.” Yoga can help. “For the Westerner in particular,” he says, “yoga keeps the body busy so the mind can meditate.” Music is another powerful soother, he says, because, like smell, it bypasses the brain’s thinking center and “goes straight to the emotional center.”

Relaxation techniques are invaluable, says Susie Hayes, as are simple things such as spending more time with loved ones and getting quality sleep. Translating a favorite quote from ancient Chinese medical texts, she says, “Either think or don’t think. If you think, you must make a decision and take action. Otherwise, don’t bother thinking.” We underestimate the negative impact of worrying about things we can’t do anything about, she says. A calm mental state is critical to disease prevention, especially for the heart.

Heart disease takes many people by surprise. The results of mediocre diets and insufficient exercise, after all, often take years to catch up with us. One such person is Leon Schnitzspahn, who, at 58, had a minor heart attack. Although he had a family history of heart disease—his older and younger brothers each suffered heart attacks in their 40s and 50s—he says he still “figured it wouldn’t happen to me.”

Then one morning in March 2002, Schnitzspahn woke up with aching arms and agitation, yet he went to work that day unaware of the seriousness of his condition. He did make a doctor’s appointment for the following day just to be sure. When the doctor told him he’d had a mild heart attack, Schnitzspahn realized it was time to change his lifestyle.

Prior to the heart attack, Schnitzspahn says he was like a lot of people, focused on his work and family and not thinking much about his health habits. The banker worked long hours in Manhattan, commuting up to two hours both to and from his home in New Jersey. Once a marathon runner, he had long since given up running and didn’t belong to a gym. He occasionally felt winded on the three flights of stairs coming out of the subway but chalked it up to age and years of closet smoking. After his heart attack, with the help of his doctor and the support of his wife, Karen, Schnitzspahn started a regular exercise routine. He now works out for an hour every day on the NordicTrack or stationary bicycle and walks briskly for another hour.

Schnitzspahn knew that he’d also have to make dietary changes to improve his health. One of the first things he changed was the ten to 15 cups of daily coffee he drank to help him meet his work deadlines. Now retired, he’s down to no more than three cups a day. His doctor suggested he add red wine to his daily diet to take advantage of its reported ability to raise “good” HDL cholesterol levels, a prescription Schnitzspahn thoroughly enjoys.

Schnitzspahn, an avid cook, imagined changing his eating habits would be much more difficult than it actually was. “At first I thought I’d be eating rice cakes for the rest of my life,” he recalls, “but it’s really not that bad.” He’s made many heart-healthy cooking improvements, such as substituting healthy olive and canola oils for butter and shortening and replacing fattier foods with tasty, heart-smart dishes, such as Mediterranean rice and lentils and curried tofu or chicken with spinach and walnuts. And, in addition to taking the heart medications his doctor prescribed, Schnitzspahn now takes a daily multivitamin, plus extra B vitamins and folic acid, which have been shown to protect the heart’s arteries from developing blockages.

Looking back on his pre–heart attack life, Schnitzspahn says, “I wouldn’t want to go back to my old habits,” because he feels so much better and more alive now. He also recognizes that positive change takes time. “I learned from running that you can’t start out thinking, ‘I’m going to run a marathon tomorrow or next week.’ It can take years. It’s the same with lifestyle changes. You can’t do it today or tomorrow, but if you come up with a plan—maybe even a five-year plan—you’ll get there.”

When 65-year-old Annie White started to experience pain in her upper back, she didn’t think too much of it. After all, for years she had suffered from neck and back pain associated with injuries sustained in a car accident. “I considered a heart attack,” she says, “but ruled it out because the pain wasn’t going down my arm, and my heart didn’t hurt.” The area between White’s shoulder blades continued to grow more painful, however, and by the fifth day White went to an emergency clinic to make sure she was all right. Both her parents had suffered heart attacks, so she needed to be cautious.

At the clinic, White was told she was having a major heart attack, and if she had waited a few more days, the damage would have been irreversible. Shocked, White couldn’t imagine why she wasn’t in more excruciating pain. She also wondered why the proactive steps she had taken—she was on medication to control her high blood pressure and had quit smoking and drinking alcohol a decade earlier—hadn’t stopped this from happening.

After having a stent put in, White was released from the hospital, and at that moment she began to approach her health differently. She decided it was time to make her health her number-one priority. To this end, White continued to see her acupuncturist, increasing to two or three times a week. In addition to the medications prescribed by her cardiologist, she began taking Chinese and Ayurvedic herbs, including guggulsterones (Commiphora mukul), an Ayurvedic herb used to lower “bad” and increase “good” cholesterol, and the Chinese herb compassionate sage (hu po yang), a tonic for “heart spirit,” which often is used to alleviate anxiety and improve sleep.

Before the heart attack, White, who is a political activist, says she wasn’t as fit as she should have been, so she also began walking two miles a day, which she’s continued to do for the last four years. White also redoubled her efforts to eat well, avoiding red meat and emphasizing organic fruits and vegetables. She added supplements to her diet, including calcium, vitamin E, and vitamin B12, all of which have been shown to help reduce the risk of heart disease. But, perhaps most significant, she says, she’s learned the importance of slowing down and de-stressing. “I had been under a great deal of stress for years—taking care of my ailing husband and working to republish his books when he died,” says White. Stress, she believes, plays a far greater role in heart disease than most people realize.

Today, White is as politically active as ever. “People [in Salt Lake City] tell me, ‘Oh, but we can’t do anything about the poison in the air,’” she says. “And I tell them, ‘Yes, you can!’” And though she can’t resist getting involved in causes she cares about, she now takes more time to nurture herself—she practices yoga, prays, reads inspirational books, and listens to soothing music. She’s even hiked to the tops of some of the beautiful mountains that surround Salt Lake. “I’m always amazed that I can do it,” she says proudly. “I’m in pretty good shape right now. People don’t believe I’m almost 70.”